Some Causes and Features of Vaginal Bleeding During Early Pregnancy
Some Causes and Features of Vaginal Bleeding During Early Pregnancy
Cause |
Common Features* |
Diagnostic Approach†,‡ |
Pregnancy-related (obstetric) disorders |
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An ectopic pregnancy (an abnormally located pregnancy—not in its usual place in the uterus) |
Sometimes only slight vaginal bleeding Abdominal or pelvic pain that Usually tenderness when the pelvic examination is done If the ectopic pregnancy has ruptured, fainting, light-headedness, or a racing heart |
A blood test to measure a hormone produced by the placenta (human chorionic gonadotropin, or hCG) Ultrasonography of the pelvis Sometimes laparoscopy (insertion of a viewing tube through an incision in the abdomen) or laparotomy (surgery involving an incision into the abdomen) |
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A miscarriage that |
Vaginal bleeding, sometimes with passage of tissue from the pregnancy Crampy pain in the pelvis and throughout the abdomen |
Sometimes a doctor’s examination alone Usually tests as for ectopic pregnancy |
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Septic abortion (infection of the contents of the uterus) |
Fever and chills Constant, severe abdominal pain, Abnormal vaginal discharge that may look like pus and may be foul-smelling Often in women who have had an intentional abortion (often done by untrained practitioners or by the women themselves) |
Ultrasonography of the pelvis Cultures of samples taken from the cervix |
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A hydatidiform mole (abnormal placental growth with or without a fetus due to an abnormally fertilized egg) or another form of gestational trophoblastic disease |
A uterus that is larger than expected No heartbeat or movement detected in the fetus (or no fetus) Sometimes high blood pressure, swelling of the feet or hands, severe vomiting, or passage of tissue that resembles a bunch of grapes |
Tests as for ectopic pregnancy A biopsy if no pregnancy is seen in the uterus |
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Rupture of a corpus luteum cyst (which develops in the structure that releases the egg after the egg is released) |
Abdominal or pelvic pain that Most common during the first 12 weeks of pregnancy |
Tests as for ectopic pregnancy |
Disorders unrelated to the pregnancy |
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Vaginitis (inflammation of the vagina, often due to infection) |
Only spotting or slight bleeding Vaginal discharge Sometimes pain during sexual intercourse, pelvic pain, or both |
Testing for sexually transmitted diseases using samples taken from the cervix |
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Cervicitis (infection of the cervix) |
Only spotting or slight bleeding Sometimes tenderness when the pelvic examination is done, abdominal pain, or both |
Testing for sexually transmitted diseases using samples taken from the cervix |
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Polyps (fingerlike growths) in the cervix, which are usually benign |
Slight bleeding No pain Polyps sometimes seen protruding from cervix |
A doctor’s examination alone Follow-up visits to further evaluate the polyps |
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Injury |
A tear in the cervix or vagina Possibly due to a procedure such as amniocentesis |
A doctor's examination alone |
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* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. |
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† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing. |
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‡ A urine pregnancy test is typically done if women have had only a home pregnancy test. Because an ectopic pregnancy can be very dangerous, tests are done to check for ectopic pregnancy in most pregnant women with vaginal bleeding unless symptoms clearly point to another disorder. |
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